Basic Information
| Provider Information | |||||||||
| NPI: | 1447221940 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIANG | ||||||||
| FirstName: | CASSIE | ||||||||
| MiddleName: | LAI KU | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 N IRBY ST | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295012808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436679414 | ||||||||
| FaxNumber: | 8436671362 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 W SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | MANNING | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291022925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034334321 | ||||||||
| FaxNumber: | 8034330075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 30140 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 301408 | 05 | SC | MEDICAID | 30140 | 01 | SC | SC STATE LICENSE # | OTHER | AA21187566 | 01 | SC | MEDICARE PTAN | OTHER | BL9360431 | 01 | SC | SC DEA # | OTHER |